Gearing Up To Fight Coronavirus

Of Bharat
bandhs, the days it was a form of potent protest, it used to be claimed in
officialdom that they passed off peacefully. Those were the times when the
Opposition declared a strike, or labour leaders brought the city to a halt, or
the railway lifeline was impacted as motormen and guards decided to teach the
government a lesson.

Of the so-called ‘janata’ bandh, it may be said, that the
Sunday last passed off quite mindlessly. Many obedient, some coerced, the rest
quite unconcerned, our people decided to follow the instructions of the Prime
Minister and sat at home as their contribution to fighting the threat of
COVID-19. A large number even participated in the beating of the ‘thalis’,
turning what is mostly understood as a form of democratic protest into an
instrument of compliance. It comes under a polity that has been marked
increasingly by demands of sacrifice, compliance and obedience to authority.
Remember ‘note-bandi’? Well, as the meme doing the rounds correctly pointed
out, this is ‘ghar-bandi’.

To be sure, the Prime Minister used the word “request”
four times in his address to the nation on March 19, when he called for the
‘janata’ curfew. But the undertone of the narrative and the way it was executed
makes the message very clear. Buckle up for the coming war against
COVID-19. We, as the Prime Minister had
said, “will have to further strengthen our resolve to overcome this global
crisis, fulfilling all our duties as citizens, and abiding by the directions
given by the central and state governments.” This is a call to fight a war and
save a nation, and so the nationalistic fervour is here and demanding
acceptance of orders and enforcing compliance. There is politics to this
narrative that clashes with the approach and the spirit with which doctors and
health experts work.

This tone from the leadership brooks no questions, and it
is not surprising that we have had very few questions out in the open from
virologists, epidemiologists and a host of other experts on what should be our
best approach to prepare for what is the likely rise of the pandemic in India.
And it is precisely questions that we must ask in these troubling times. For
example, the Prime Minister also asked people to “resolve to not get infected
ourselves, and prevent others as well from getting infected”. Which begs the
question, as simple as it is complex, how does one do so? But not challenging
the narrative coming from above, which is what happens when a top-down approach
from an overwhelming authority is followed, delivers a high degree of blind
compliance. The focus is soon shifted to how we all managed a Bharat bandh and
beat up vessels to make a loud sound exactly at 5 pm on March 22, as the Prime
Minister had desired. This is buffoonery at its best.

Those humbler in the face of a grave crisis will ask more
questions and resist the rush to provide answers and deliver quick fix
solutions. Should we not ask what the purpose of closing down railways, taxis,
and indeed Uber and Ola services is, and the amount of hardship these could
cause to those who must reach somewhere – to attend to an ailing child, parent
or to seek medical attention? The poorest with no means of their own transport
will be affected the most. What is the price the nation will pay as tens of
thousands of daily wage workers thronged the railway stations to get into
trains and get back to their home states, with wages here gone and no hope of a
quick revival? There should be worries that some of them have carried the
disease far away and to remote corners of India, where it will be difficult to
fight. There are other concerns on a one-day lockdown and what happens on the
next day as people return to the streets and the markets resume trading and
other activity though on a subdued scale. Can we really “fool” the virus? We
can never say for sure but the chances are that we may more likely fool
ourselves.

Across the world, as it has been in India over the years,
the public health approach is sought to be understood more from the perspective
of the patients. It is well understood that TB cannot be fought when those
suffering do not follow instructions or do not take medication as prescribed
over a long period of time. So, protocols are formulated to encourage patients
to take their dosage and to return for timely follow-ups. Injectable contraceptives
were not introduced in the national family welfare programme because (the
government introduced these in the public sector only in 2017) of their
longer-term effect, the problems with informed consent in India and risks that
were not as well understood. This is even though injectables have been sold in
markets like the United States and other parts of the developed world for
decades.

This narrative, with the interest of the patient at the
core, takes a beating with a top-down handling, and runs the risk of becoming
the weakest link in the resolve to fight the threat from COVID-19. Whenever
patient rights are sacrificed and administrative action sans inputs from the
larger collective of health workers takes the lead, disaster follows. A good example
is the sterilisation campaign under the influence of Sanjay during the
Emergency, which tarred the programme for ever.

From the perspective of patients, the government must
gear up to provide more information that can help people take decisions and act
in a crisis. This must cover issues like where do people who have symptoms go
for testing. Currently, only a limited number of labs test for COVID-19. If the
number of cases rises, what are the preparations to house people, keep up
communications, set up new protocols and maintain a sense of order? Just like
we are being assured of enough supplies of commodities, it will do well to keep
the nation posted on number of isolation wards, hospital beds, test centres and
availability of medical supplies where required. This means gearing up the
entire health infrastructure and the state machinery to serve more, to reach
out more, to support from the top and to hold the authorities to account when
they fail to do so. This must be the spirit. And alongside, we can have lesser
trains, restrictions on crowds and working from home.

That is a very different kind of preparation and focus
from what we saw last Sunday with the police enforcing the ‘janata’ curfew,
shockingly beating up people venturing outside in many parts of the nation. It
is something to reflect on: we have started the fight against a pandemic by
beating up our people. Violators of the “order” from above are being punished.
Then we have congratulated ourselves. And we really do think we are prepared!